Withholding Medication

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Will I get into trouble for withholding a non-PRN medication?

It is definitely within a licensed nurse's scope of practice to withhold routine medications per our nursing judgment. However, since the routine medication has been ordered by a physician for a presumably valid reason, the licensed nurse who holds the medication needs to notify the ordering doctor to notify him/her that the med was held.

Charting that a routine, non-PRN medication was held is not satisfactory enough UNLESS the physician's order contains parameters or further directions to "hold medication if ___ happens." For instance, many antihypertensive medications are ordered with parameters to hold if the systolic blood pressure is below a certain number, and many laxatives are ordered with directives to hold if loose stools are noted.

If there were no physician's parameters for holding the charcoal or no directions to "hold charcoal if ___ happens," then you must call the ordering doctor to make notification that you held it and disclose why you held it. This covers you and shifts responsibility to the doctor, who will then tell you to either give the charcoal anyway or agree with your decision to hold it.

After notifying the ordering physician of your decision to hold this routine med/treatment, you document that you held it, as well as your notification including dates, times, and the doctor's response.

Also, company policy often has a policy for holding routine medications.

I could not find the physician's number. He doesn't visit everyday (according to the medical notes).

Since physicians have 24-hours a day/7 days a week liability over their patients, it is imperative that you have the doctor's number. Make it a priority to obtain the physician's number because, if a change in condition ever transpires, the patient's physician needs to be called.